Processed food debate fuels folic acid fortification confusion ahead of UK deadline

The UK is mandating fortifying flour with folic acid by the end of this year to help prevent birth defects. However, ACI Group has noted consumer confusion surrounding this move, given fortification’s association with processed foods, despite its proven benefits.

Nutrition Insight speaks with Gareth Clark, sales director at ACI Group, who urges for greater industry-driven awareness about fortification’s purpose and benefits to combat misinformation and build consumer confidence before the policy implementation deadline.

The legislation was introduced in 2024, requiring millers and flour producers to fortify non-wholemeal wheat flour with folic acid, with measures coming into force by December 13.

Root of misunderstandings

According to Clark, people can misunderstand food fortification, which has become an “unintended casualty” of broader debates over processed foods. 

“Many consumers now associate the term ‘added’ with something artificial or unnecessary, without realizing that fortification has been used safely for decades as a public health tool to address nutrient gaps.” 

“As a result, fortification is often conflated with food additives and ultra-processed food in general, despite its vastly different purpose,” he explains. 

The UK already fortifies flour with calcium, niacin, thiamine, and iron. However, this lack of awareness and historical context is missing from discussions.

“International evidence demonstrates the effectiveness of fortification, showing that countries with mandatory folic acid fortification have 50–100% higher average folate levels and up to 50% lower rates of neural tube defects compared with countries without such policies,” underlines Clark. 

The UK will require folic acid fortification of non-wholemeal wheat flour by the end of 2025 as a public health measure to prevent neural tube defects.“Without this broader understanding, the benefits of fortification are easily overlooked or misunderstood.”

Folic acid focus

The UK decided to focus specifically on folic acid, as strong health evidence shows persistent folate insufficiency.

“Folic acid plays a critical role in reducing the risk of neural tube defects in the human fetus during early pregnancy, yet a significant proportion of individuals, particularly younger women and those who suffer from certain nutrient deficiencies, are not getting enough folate through diet alone,” says Clark.

“UK nutrition data shows that between 2019 and 2023, 83% of women of childbearing age had red blood cell folate levels below the 748 nmol per liter threshold associated with a reduced risk of neural tube defects, highlighting a clear population-level nutrient gap.” 

According to government data, 12% of children aged 11 to 18, 4% of adults aged 19 to 64, and 2% of adults aged 65 years and over were considered to have low folate intake. This is why folate fortification of non-wholemeal wheat flour is becoming mandatory, which is expected to prevent 200 neural tube defects every year in the UK.

“The legislation reflects recognition that population-wide fortification provides an effective, inclusive safety net to improve public health outcomes, as evidenced in other countries where folate supplementation is mandatory, including the US since 1998, Australia and New Zealand since 2009, and South Africa since the early 2000s,” says Clark.

Consumer trust and public safety-net

ACI Group does not expect people to refrain from consuming flour products in the long term due to the regulation.

“While some initial concern may arise, this is typically driven by headlines and misinterpretation of the science rather than any evidence of harm,” notes Clark.

“Historical experience from other countries shows that fortification policies have not led to sustained reductions in the consumption of staple foods such as bread, which remain dietary essentials.”

He believes that consumer confidence will follow as awareness of folic acid fortification’s key role in protecting fetal growth, even before pregnancy, increases. 

“Importantly, fortification does not materially change the sensory qualities or textural qualities of flour-based goods — ensuring that taste remains the same for consumers while reinforcing its role as a safe and effective public health measure.”

Furthermore, Clark notes that supplements and fortified foods are complementary and not competitors. “While folic acid supplementation before and during early pregnancy is critical and strongly recommended, fortified foods provide a passive, everyday way to improve nutrient intake across the whole population.”

ACI Group does not expect people to refrain from consuming flour products in the long term due to the regulation.“However, there is evidence that shows that only a minority of women take folic acid before conceiving, with studies historically suggesting fewer than one in three women do so, meaning many pregnancies remain unprotected in the earliest stages.”

In foods, folic acid is naturally found in spinach, dark leafy greens, liver, and nuts and seeds. However, since not everyone eats these foods, fortified staple foods cover entire populations — “reaching individuals regardless of supplement use, access to nutrition advice, or pregnancy planning.”

Raising awareness before deadline

Clarke advocates that the nutrition industry should responsibly lead with clarity and transparency before the fortification deadline.

“Brands, manufacturers, and ingredient suppliers can play a critical and proactive role by clearly explaining what fortification is, why it is being implemented, and how it benefits public health, particularly in light of documented folate insufficiency and the role fortification is expected to play in preventing birth defects.”

“Clear on-pack communication, consistent messaging, digital outreach, and education campaigns, alongside collaboration across the supply chain, will be key to countering misinformation and building consumer understanding,” he suggests. 

In previous headlines around food fortification, recent clinical research supported Balchem’s choline-enriched L-5-methyltetrahydrofolate folate ingredient, Optifolin+, to be 2.6 times more bioavailable and 3.5 times more quickly absorbed than standard folic acid in healthy adults. Moreover, Nutrition Insight previously talked with Balchem about additional health benefits of folate in healthy aging. 

Gnosis by Lesaffre found that its Hy-Folic provides double bioavailability compared to folic acid in a clinical study.